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California Cracks Down On Genetic Testing

Posted by kdawson on Tue Jun 17, 2008 04:43 PM
from the first-salvo-in-a-long-campaign dept.
genie-out-of-the-bottle writes "California's Department of Public Health has sent cease-and-desist notices to 13 companies that market genetic testing directly to consumers. (We discussed these services when they launched.) Allegedly, under state law, California residents must submit a doctor's order to have a genetic test run. It will be interesting to see if the government will actually succeed in putting the genetic genie back in the bottle, given that all you need for testing is a few drops of saliva. The effort closely resembles US government attempts to block export of strong encryption product back in '90s." A Wired editor has up an opinion piece arguing that his DNA is his business and none of the government's.
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story

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[+] Direct-To-Consumer Genetics Testing Makes a Splash In Boston 78 comments
eldavojohn writes "MIT's Technology Review has the scoop on the first annual Consumer Genetics Show starting today in Boston and it looks like the rage these days is genetic testing sans the middle-man physician. And it's getting more prevalent and more available: 'A number of companies offering direct-to-consumer genetic testing have cropped up in the past two years to capitalize on these advances, from 23andMe and Navigenics, which offer genome-wide scans to identify specific disease-linked genetic variations, to Knome, which offers whole-genome sequencing to the wealthy. Any doubts that personal genomics is making its way into the mainstream can be assuaged with a look at Interleukin genetics, a startup that sells genetic tests for heart-disease risk, B vitamin metabolism, and other factors through Amway, the direct-sales company.' Over-the-counter genetic tests may be much closer than you think. The article raises concerns that this information will be misused/misinterpreted or even provide a false sense of security. We've discussed some states prohibiting this last year."
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eldavojohn writes "A hundred thousand elderly Californians (average age 65) will be gene sequenced by the state using samples of their saliva. This will be the first time such a large group has had their genes sequenced, and it is hoped to be a goldmine for genetic maladies — from cardiovascular diseases to diabetes to even the diseases associated with aging. Kaiser Permanente patients will be involved, and they are aiming to have half a million samples ready by 2013. Let's hope that they got permission from the patients' doctors first."
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  • by Reverend528 (585549) * on Tuesday June 17 2008, @04:47PM (#23829791) Homepage

    Regulation should protect me from bodily harm and injury, not from information that's mine to begin with.

    Sorry Tom, but the information isn't yours. Much of "your" DNA is patented. If you don't intend to pay the licensing fees, then you should expect to receive a C&D shortly.

    • by MiniMike (234881) on Tuesday June 17 2008, @04:52PM (#23829911)
      I bet they'll want the first instance of derivative works too...
    • by oodaloop (1229816) on Tuesday June 17 2008, @04:54PM (#23829927) Homepage
      Patenting DNA was a problem maybe 10 or so years ago, but since then much of the patents and patentable information on DNA has been collected in open repositories of information. Drug companies have found it much more lucrative to open up this information and share it with other companies rather than keep it to themselves - shouldn't be too surprising to open-source enthusiasts. Instead, they have been concentrating on deriving income further downstream from the drugs produced from the DNA data. Right now, most of your DNA is open-source.
      • by MightyMartian (840721) on Tuesday June 17 2008, @05:01PM (#23830075) Journal
        The issue is that these companies did not create the DNA. It was yet another abuse of the patent system, and the courts and the government didn't have the balls to ban it outright. If it ain't an invention, it shouldn't be patentable.
        • by WaltBusterkeys (1156557) * on Tuesday June 17 2008, @06:17PM (#23831315)
          It's a pretty common misperception that somehow humans would have to pay license fees for use of DNA.

          What was being patented was a purified sequence of DNA for use in a diagnostic test. It's not the DNA itself--there's 10 million years of prior art for that--but the use of a particular sequence of DNA for diagnostics.

          The total human genome is over 3 billion base pairs. Companies were racing to figure out which small sequences (100 or so pairs) would be useful in diagnostics and possibly in therapy. The use of DNA for that purpose was completely new at the time.

          For example, check out this DNA patent application [uspto.gov]. The application refers to a specific DNA sequence, but the patent itself is for the use of that particular sequence for a specific kind of therapy.

          It's still perfectly legal to reproduce, sell your DNA in a bottle, and so forth. The only thing the patent covers is the use of one very short sequence in a particular kind of therapy.

          It might still be bad policy, but it's not as if you don't own your DNA.
    • so now we have the GIAA Genetic Industry Association of America to worry about

      thanks dude!
      • by stranger_to_himself (1132241) on Tuesday June 17 2008, @06:01PM (#23831137) Journal

        A lot of commercial genetic testing is scientifically worthless, even harmful if they give you bad information about what your genetics actually means for you or your children. There needs to be some kind of regulation (regarding claims they can make, information supplied to customers, actual evidence for the disease-test relationship they claim etc), but at the moment the public health people can't agree on what form that regulation should take, so there might be a lot of this 21st century snake-oil around for a long time.

        I don't know anything about California, but it could be that the government is trying to protect people from possible harms of bad and unnecessary testing.

        • by RDW (41497) on Tuesday June 17 2008, @08:00PM (#23832613)
          'I don't know anything about California, but it could be that the government is trying to protect people from possible harms of bad and unnecessary testing.'

          The interesting thing is that this technology is evolving so rapidly that the type of testing California is cracking down on is going to look quaintly prehistoric in just a few years. Roche is expected to launch a commercial high resolution version of its 'sequence capture' platform in the next few months which, combined with a 'next generation' sequencing system (like Roche's own 454 machine), should allow complete human 'exomes' (all the well-defined mature gene transcript sequences in a sample) to be completely sequenced for a few thousand dollars. But this, of course, is just the first step. One or more of the future sequencing technologies currently in development is likely to bring entire human genome sequences into this price range:

          http://genomics.xprize.org/ [xprize.org]

          with the eventual Holy Grail of a '$1000 genome' now seeming pretty much inevitable. But some of the teams competing for the genomics X-prize don't intend to stop there - e.g., Reveo claims to be aiming to produce a practical nanotechnology-based instrument 'in 5-10 years that will cost less than $1000 and sequence the whole genome and simultaneously the epigenome (methylation code) nearly error free in a minute for pennies per genome.'

          So what happens if it's possible to buy an extreme throughput sequencer for the price of a laptop, and decode a genome as effortlessly as cracking CSS on a DVD? Is this particular genie really likely to stay in the bottle? And is it in any case defensible that knowledge of an individual's genome should ('for his own good') remain the province of an exclusive medical priesthood, rather than of the individual himself?
          • by stranger_to_himself (1132241) on Tuesday June 17 2008, @07:34PM (#23832293) Journal

            Do you have any actual data that backs this up?

            The US Government Accountability Office compiled a report of genetic testing that is available here [gao.gov], although it's only a smallish snapshot of the current situation.

            Both the positive and negative implications for widespread genetic testing are favourite subjects of Ron Zimmern and Muin Khoury, and if you're interested you'll find a lot of discussion of genetic test regulation by searching for them. There's a newspaper report of a study by Khoury here [guardian.co.uk], but annoyingly I can't find the original work.

  • There have been a lot of initiatives like this that are designed to make money for doctors.
    • Re: (Score:3, Insightful)

      While there are some half-decent arguments (reactionist people taking tests then making up their own "treatment" plan for their 1% chance of developing condition X), I agree this is for doctors.

      These kind of rubber stamp things (since I assume most doctors would just say "yes" to simplify their lives) just raise health care costs. By requiring this signature you take up the doctor's time and it's harder for you to compare and get things done.

      This seems like regulation for the sake of regulation to me.

      • by Robert1 (513674) on Tuesday June 17 2008, @05:12PM (#23830347) Homepage
        Actually it won't be rubber stamped. Unless the individual has some family history of the genetic disease or symptoms which are suggestive of it genetic testing is NOT OFFERED by physicians.

        Likewise if a family member has such symptoms or his side of the family has these traits, genetic testing is disallowed unless the person actually agrees to it. I.e. a wife wants to know if her husband has Huntington's, she cannot force him to take a test or bring a sample to a physician and ask for it to be tested. Even if she only wants the information for future conception, the doctor won't allow it.

        What's to keep someone - anyone - your wife, boss, insurer, whoever, from taking that toothpick you used after lunch and sending it in to one of these companies?

        I think the law is intended to protect YOU from others, not from yourself. If you actually have some problem then you can go to a physician and have total confidence that the only person who will know the result is you and him. Hell, you can even withhold it from him if you wish. As it is now a person can send in ANYONE'S DNA and get their result.

        I'd rather go to a doctor than leave that second option as a possibility. That's the option that leads down the road to real Gattaca-style shit. It's a future I'd rather NOT live in.
        • What's to keep someone - anyone - your wife, boss, insurer, whoever, from taking that toothpick you used after lunch and sending it in to one of these companies?

          Please, that will never happen. You're just being paranoid. And of course, such irrational paranoia is exactly the type of behavior I would expect, given that you have a repeating ATTCAGGGATTAG sequence on your chromosome 3, which results in a 500% increase in the risk of developing paranoid schizophrenia.

      • Re: (Score:3, Insightful)

        (since I assume most doctors would just say "yes" to simplify their lives)

        While this _would_ increase the number of office visits, it's likely that it would not generate a great deal of revenue, since it would likely be coded at the lowest level.

        I know a number of primary care physicians, and this just isn't the type of visit that they would try to encourage. Furthermore, most physicians I know (IMHO all responsible ones) would discourage unwarranted genetic testing, as well as any other type of medica
        • Re: (Score:3, Interesting)

          What's that about "outcome"? If you're getting an informational test done -- without the intent or expectation that it will diagnose or treat any disorder, but in the interest of getting a CD with interesting statistical information (with the explicit understanding that that interesting information isn't to be used in relationship towards diagnosis or treatment, and that the relationship between the data provided and any expected implications thereof will evolve/change over time as the science improves)...
          • $1000 is not much money, and I'd find it interesting to have access to the data out of sheer intellectual curiosity -- and I find it offensive that anyone would find it to be their responsibility to "protect" me from doing that. What's next, "protecting" people from blowing their money on space tourism, or on visiting museums?

            It's a case of balancing the risks against the rewards. Sure you might find it interesting, but a lot of people will get tests which are often meaningless medically and which they will base lifestyle or health choices on.

            I'm not sure on which side of the argument I'm on at the moment, but I'm very nervous about the prospect of people selling tests for disease genes without any requirement for evidence of the disease-gene interaction, and for the correct information for the implications to be supplied to customers.

            Would you like to know your SORL1 genotype? What if I told you it was possibly liked to Alzheimer's disease? What if I told you it was definitely liked to young onset Alzheimer's disease, but I was lying? Would you like your wife's genotype? How would you interpret the information? I understand the intellectual curiosity and freedom points of view but this can do harm as well as good.

  • by locallyunscene (1000523) on Tuesday June 17 2008, @04:55PM (#23829937)
    I think this has more to do with privacy than "keeping your data from you". Ask it stands now what's to stop you from sending a cheek swab with your neighbor's DNA instead of yours under a false name? If a doctor is involved at least the perpetrator must make a face to face appearance under the fake name with someone who would be "accountable" before being able to carry through with his plan.
    • by MightyMartian (840721) on Tuesday June 17 2008, @04:57PM (#23829989) Journal

      I think this has more to do with privacy than "keeping your data from you". Ask it stands now what's to stop you from sending a cheek swab with your neighbor's DNA instead of yours under a false name? If a doctor is involved at least the perpetrator must make a face to face appearance under the fake name with someone who would be "accountable" before being able to carry through with his plan.


      Perhaps what should be banned is accepting DNA samples indirectly.
  • by Paranatural (661514) on Tuesday June 17 2008, @04:59PM (#23830033)
    As I understand it, you don't actually have to be present at their offices to provide the DNA Sample.

    What kind of crap is this? So, basically, I could collect the saliva (Don't ask how) of various people I know, send it in, and have ready access to their genetic information? HIPAA should be all over this like white on rice. With no actual strong safeguards on this stuff anyone could theoretically easily gain access to your genetic profile.

    A better solution is to be able to do it freely, you actually have to show up at the lab and be able to certify you are who you say you are. Perfect? No, but better than how it was being done.
      • by Paranatural (661514) on Tuesday June 17 2008, @05:19PM (#23830511)
        Because without the ability to read it we lack the ability to use it to discriminate.

        Say, for instance, your employer were able to collect you DNA. How is immaterial at the moment. Your company does this, and gets you profiled. Uh-oh, high risk for cancer. So they fire you so their insurance premiums won't go up. Also, can you imagine how much that information is worth to your insurance company?

        Yes, there are already some laws on the books against genetic discrimination, but a lot of places don't have to tell you why they fired you, and if you didn't know they got the DNA...

        Besides, it's just plain a privacy issue. My DNA is my business. Not yours. However, with the mail-in DNA testing, if you were to get some of my DNA, you could find out what's in my DNA. Why do you think you should have that right?
        • by lgw (121541) on Tuesday June 17 2008, @05:29PM (#23830695) Journal
          Or, we could just stop using companies as insurance providers, and that whole problem goes away. It's just a stupid situation we've become trapped in. Further, insurance is supposed to protect you against risks, not certainties.

          If you're a bad driver, should you not be charged more for liability insurance. If you've a genetic redisposition towards an expensive for of cancer, should you not pay more for the that? If you've have a genetic condition that carries the certainty of expensive treatment, then insurance isn't even relevent, you need a budget (or charity) not proection against risk.

          Why people what to conflate health insurance and charity is beyond me - insurance companies are just about the worst possible choice as charity providers.
  • by sammaverick (771437) on Tuesday June 17 2008, @05:06PM (#23830183)
    California requires a doctor's order form for not just genetic testing. The company I work for (www.biophysicalcorp.com)(is it kosher for me the link my company here?) does direct-to-consumer blood/ biomarker testing, and for California and about 9 other states, the individual consumer can not just order the test from us, they have to have their doctor sign a order form (Which creates a hassle for us and the client).

    Heck, in a few states (Cali included) we can't even send the client their report, we have to send it to the doctor's office.

    I am pretty sure this law is in effect partially to protect the interests of the doctors in general.
  • by cortesoft (1150075) on Tuesday June 17 2008, @05:08PM (#23830251)
    I am not usually one to jump on the anti-regulation bandwagon. I appreciate the need for restrictions on many practices, and regulatory agencies to make sure people practicing in the industry are competent and perform their jobs safely. HOWEVER, this seems like something that should be outside the realms of regulation (of this sort). There is no medicine being practiced here; there is no diagnosis, no prescription, no anything of that sort going on. They don't perform an exam, they don't even touch the customer (in fact I am pretty sure these companies don't even SEE their customers). In fact, I find it hard to even classify what they are doing as being in the medical field at all - they don't claim to diagnose or cure any disease. Given the rampant availability of 'natural' cures for things that have no regulatory body overseeing them, why is this something that needs to be regulated? Those 'natural' cures and supplements ARE saying they cure diseases(disclaimers not withstanding), with zero regulatory oversight. How is knowing my DNA sequence more dangerous to me than taking unknown, unregulated herbal supplements? The government's job shouldn't be to require someone act as a filter for my own personal information. My own personal information is not 'dangerous', and I do not need someone holding my hand while I find out about it; if we hold to this view, how is it different than saying "We need to restrict public access to this information about scientology because if people read about it without someone to interpret it for them, they might believe it to be true and that could cause them harm." I can protect myself from this dangerous information, thank you very much.
    • by Actually, I do RTFA (1058596) on Tuesday June 17 2008, @05:08PM (#23830261)

      ...behind those restrictions? Do you also need a permission to measure your weight, or to look in the mirror?

      Because it would be very easy for me to collect saliva from someone whom I know in real life, and run tests on their DNA without their knowledge or consent. Also, there is a desire to prevent coersion towards that same goal.